2. Regulations 

The program is governed by Louisiana Medicaid regulations. Providers must comply with regulations set forth by the Louisiana Department of Health (LDH) for home- and community-based services providers 

3. Licensing or Certification 

Providers must be certified by Louisiana Medicaid to offer PERS services. No specific license is mentioned, but providers must be authorized dealers, suppliers, or manufacturers of PERS 

4. Responsible State Agency 

The Louisiana Department of Health (LDH) oversees the certification process for PERS providers through the Medicaid program 

5. Application Process 

The application process requires submission by mail. Providers must submit a completed application form and required documentation to: 

Unisys Provider Enrollment Unit 
PO Box 80159 
Baton Rouge, LA 70898-0159 

6. Required Documentation 

The application packet must include: 

• Completed Louisiana Medicaid PE-50 Enrollment Form 

• Completed PE-50 Addendum – Provider Agreement 

• Copy of IRS document showing Employer Identification Number (EIN) 

• Completed LA Medicaid Entity Ownership Disclosure Information form or Individual Disclosure Information form 

• Completed Medicaid Direct Deposit (EFT) Authorization Agreement 

• Copy of voided check for electronic fund deposits 

• Documentation proving the applicant is an authorized dealer, supplier, or manufacturer of PERS 

• EDI contract and Power of Attorney (if applicable) for electronic claims submission 

7. Timeline for Approval 

The exact timeline for approval is not specified in the provided information. However, providers should expect the process to take several weeks to months, depending on the completeness of the application and the current workload of the enrollment unit 

8. Pre-Application Process 

There is no specific pre-application process mentioned. However, providers must ensure they meet all eligibility criteria before applying 

9. Pre-Application Training 

No specific pre-application training is mentioned for PERS providers 

10. Additional Notes 

• Providers must include any and all Medicare provider numbers they want linked to their Medicaid provider number 

• Upon certification, providers will be notified of their Medicaid Provider number that must be used for billing 

• A provider manual will be forwarded to certified providers 

• PERS services are available across all of Louisiana's cities, ensuring statewide coverage